Action Points

This study looked at the relationship of adherence to ideal levels of the seven AHA cardiovascular health metrics and incident cancers.

There was a significant graded, inverse association between the number of ideal cardiovascular health metrics at baseline and cancer incidence. Participants meeting goals for six to seven ideal health metrics had half the risk of incident cancer of those meeting goals for zero ideal health metrics.

People who adhered to all seven ideal health metrics as defined by the American Heart Association (AHA) reduced their risk of cancer by more than half, researchers found.

Using data from the Atherosclerosis Risk In Communities (ARIC) study with nearly 20 years of follow-up, researchers found that those who maintained goals for six or seven of the AHA metrics had a 51% lower risk of incident cancer compared with those meeting no goals, according to the study published online in Circulation: Journal of the American Heart Association.

However, only 2.7% of the cohort maintained adherence to six or seven of the health metrics, reported Laura J. Rasmussen-Torvik, PhD, MPH, from Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

"I think researchers know that healthy behaviors are associated with a decrease in cancer," James Hill, PhD, executive director of the Anschutz Health and Wellness Center at the University of Colorado Denver, told MedPage Today.

"For example, I work in the field of obesity and we know that these behaviors help reduce all the comorbidities that occur in obesity, which include diabetes and cancer, but it helps to have studies like this actually pull it together and say so," said Hill, who was not involved with the study.

Rasmussen-Torvik and colleagues agreed, saying their results are "consistent with other analyses that have demonstrated a significant association between adherence to lifestyle guidelines similar to the behaviors endorsed by the AHA and lower incidence of cancer," the investigators noted.

They did not set out to prove the association with cancer was "entirely independent of other known cancer risk factors." Rather, they wanted to gauge the incidence of cancer compared specifically with the AHA "Simple Seven."

The risk of incident cancer is reduced incrementally with nearly every health metric attained (95% CI):

One or two metrics – HR 0.79 (0.64 to 0.98)

Three metrics -- HR 0.74 (0.59 to ;0.91)

Four metrics – HR 0.67 (0.54 to 0.84)

Five metrics – HR 0.61 (0.48 to 0.79)

Six or seven metrics – HR 0.49 (0.35 to 0.69)

The hazard ratio per one increase in number of ideal health metrics was 0.92 (P<0.0001 for trend). The hazard ratios were adjusted for age, sex, race, and ARIC center.

It's already been found that individuals who met three to four of the Simple Seven heart-health metrics had a 55% lower risk of cardiovascular mortality compared with those who met no more than two of them over about 11 years.

Now a reduction in cancer can be associated with these ideal health metrics developed in 2010 by the AHA as part of its "2020 Initiative." The goal of the initiative is to improve the cardiovascular health of all Americans by 20% while reducing death from cardiovascular diseases and stroke by 20%.

To accomplish this goal, the concept of ideal cardiovascular health was defined according to seven health behaviors or factors: smoking, physical activity, obesity, dietary intake, total cholesterol, blood pressure, and blood sugar.

Rasmussen-Torvik and colleagues included 13,253 participants from the ARIC database who reported having no history of cancer at baseline (nonmelanoma skin cancer was excluded). The mean age of participants at baseline was 54, with slightly more women than men.

The percentage of participants in each ideal health category was:

71.5% -- smoking

51.8% -- blood sugar

41.6% -- blood pressure

37.9% -- physical activity

36.9% -- total cholesterol

33.2% -- body mass index (BMI)

5.3% -- ideal diet

Even when researchers removed participants whose cancer occurred within the first 3 years of the study, results were the same. But when they removed smoking, which had the largest percentage of participants with ideal levels, the risk of cancer increased for some metrics.

For example, those with three ideal health metrics had a 2% lower risk of incident cancer compared with a 25% reduced risk when smoking was included. The risk of cancer for those with five health metrics dropped from 39% with smoking as a category to 25% without.

"It appears that ideal levels of smoking are responsible for driving a large portion of the negative association between ideal cardiovascular health and cancer incidence," researchers wrote.

Rasmussen-Torvik and colleagues analyzed breast, lung, and colorectal incident cancers individually and found "a trend of lower cancer incidence with a larger number of ideal health metrics for breast cancer (P=0.11 for trend), lung cancer (P<0.0001 for trend), and colorectal cancer (P=0.0092 for trend).

Interestingly, the incidence of prostate cancer rose with a larger number of health metrics (P=0.02 for trend). Researchers suggested the inclusion of smoking as a health metric could have been responsible for this increase. When smoking was removed from the score of ideal health metrics, "the association of the score with higher prostate cancer incidence was no longer observed (P=0.40 for trend)."

Overall, researchers said that their results "should encourage the AHA in their efforts to partner with cancer and other chronic disease advocacy groups to promote the AHA 2020 goals to reduce the burden of cardiovascular disease as well as other highly prevalent chronic diseases."

The Atherosclerosis Risk in Communities Study was supported by National Heart, Lung, and Blood Institute. Researchers acknowledged the state of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped support the availability of the cancer registry data.

Rasmussen-Torvik and colleagues reported they had no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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